By Ayo Adesanmi
Introduction: Medicine and the Human Experience
There are few wounds more devastating than the wound inflicted upon a parent by the suffering or death of a child. For parents, a child is not merely a human being entrusted to their care; the child is a fragment of their own existence, a repository of dreams yet to be fulfilled, a future imagined long before it arrives. When illness strikes, parents surrender their most precious possession to the hands of those the society has trained and licensed to heal. They enter the hospital carrying fear, but also hope with the quiet conviction that, in the hands of a doctor, suffering will be relieved, danger recognised and life preserved. It is therefore, difficult to contemplate a more profound betrayal of human trust than when that hope is shattered by negligent, reckless or incompetent medical care. The anguish, agony and mental torture are not confined to the moment of injury or loss. They linger in hospital corridors, in sleepless nights, in the haunting recollection of what might have been done differently, and in the unbearable question that often survives every medical report and every judicial proceeding: could my child have been saved? Where the tragedy was avoidable, grief acquires another dimension. It is no longer grief alone, but grief accompanied by bewilderment, anger, fury and an aching sense of injustice. The parent is left mourning not only the child who was lost, maimed or permanently diminished, but also the future that child was supposed to have lived and the brilliant hope the child has nurtured.
The paradox is as painful as it is profound: the medical profession exists upon the moral promise to preserve life, yet the very hands to which society entrusts that sacred responsibility may, through serious departures from professional standards, inflict injuries that permanently alter the lives they were meant to protect. This does not mean that every unsuccessful treatment is negligence, nor that every medical complication should become the subject of criminal condemnation. Medicine is an uncertain art as well as a science, and even the most conscientious practitioner cannot command the human body with absolute certainty. But where professional competence is abandoned, basic precautions are disregarded, informed consent is neglected, warning signs are ignored, or a practitioner ventures beyond the boundaries of his competence without appropriate referral, the law is confronted with a question that cannot be answered by sympathy alone: when does medical failure become culpable wrongdoing, and when should the shield of professional judgment yield to the demands of accountability? At that frontier lies one of the most delicate problems in contemporary medical jurisprudence, it is the need to protect doctors from the unfair criminalisation of genuine clinical error while ensuring that patients are not rendered defenceless against conduct so deficient that it jeopardizes life, limb or bodily integrity. The law must therefore navigate between compassion for the fallibility of the healer and justice for the vulnerability of the patient. For behind every medical record may be a frightened child, behind every clinical decision a family placing its trust in another human being, and behind every avoidable medical tragedy parents are left to carry a lifetime of pain and pangs for a loss they should never have been asked to endure. The issues that permeate the activities of a doctor are. questions of professional responsibility, patient autonomy, reasonable skill and care, and the boundary between permissible clinical judgment and criminally culpable recklessness.
The Oxford Textbook of Medicine describes Medicine as the science and practice of caring for patients — managing the diagnosis, prognosis, prevention, treatment and palliation of injury or disease, and promoting health.¹ Medicine encompasses a variety of practices intended to maintain and restore health through the prevention and treatment of disease.
Medicine is an essential part of the human experience. The doctor, or one of his several professional aides, is usually present at some point in the life of every person, from the womb to the deathbed. Medicine ensures that the birth process is safe, makes living easier and more pleasurable, and renders death bearable. It provides relief from pain and suffering, and the healing of physical and mental illness. The profession evolves as humankind evolves and advances: developments in the biological, chemical and physical sciences have been applied to Medicine, producing great improvements in the longevity and quality of life of people the world over.
Yet in the course of caring for their patients, doctors carry out delicate and dangerous procedures that could very easily go awry. They prescribe medications capable of producing a plethora of potentially dangerous side effects. Mistakes can cause death or life-changing consequences. Unqualified practitioners, commonly referred to as quacks, cause great harm to the hapless persons who access their services — they maim, dispossess and even cause the death of unsuspecting members of the public.
The Regulation of Medicine: From Professional Mores to Statute
Medicine has been the subject of one form of regulation or another from antiquity. The Hippocratic Oath of antiquity,² Avicenna’s Canon of Medicine of the medieval period,³ and Thomas Percival’s Medical Ethics of 1803⁴ all represent attempts at the regulation of the medical profession. These were, however, more or less professional mores enforced by professional societies and medical schools.
Developments in the modern era made it necessary for society to make statutory provision for the tight regulation of the profession, to ensure public safety without impinging on doctors’ ability to practise and advance the profession for the benefit of society. This is exemplified by the Apothecaries Act passed by the Parliament of the United Kingdom in 1815.⁵ The State makes laws, rules and regulations to control the education and training of persons who seek to become doctors, to determine the minimum qualifications for registration, and to prescribe a strict code of conduct for practitioners. Beyond these purely professional provisions, the State also legislates against persons who practise Medicine illegally, or in a manner that is careless or reckless and causes harm to members of the public.
The Nigerian Regulatory Framework
In Nigeria, the Medical and Dental Practitioners Act (MDPA) is the principal legislation for the regulation of Medicine.⁶ It was first enacted by the Federal Parliament in 1963, repealed and reenacted in 1988, and amended in 1992. The MDPA established the Medical and Dental Council of Nigeria (MDCN) and vested it with authority over medical education, the registration and licensing of medical practitioners, and the promulgation of a code of conduct for the practice of the profession in Nigeria.⁷ The Act also criminalises the practice of Medicine in Nigeria by persons who are not registered as medical practitioners.
The MDPA further established two bodies for the professional discipline of persons registered to practise Medicine in Nigeria: the Medical and Dental Practitioners Investigation Panel and the Medical and Dental Practitioners Disciplinary Tribunal.⁸ The Investigation Panel is vested with the mandate of conducting a preliminary investigation into any case in which it is alleged that a doctor has misbehaved in a professional respect, or should for any other reason be the subject of proceedings before the Disciplinary Tribunal. The Panel is composed of fifteen doctors of good standing and repute in the medical profession in Nigeria. They review allegations of misconduct against doctors — allegations that are not criminal in nature and that arise from the pursuit of the profession — to determine whether the evidence suggests a violation of the code of conduct. Where the Panel makes such a determination, the doctor is referred to the Disciplinary Tribunal for trial. The Panel may also make an order for the interim suspension of a doctor under investigation where it is satisfied that allowing the doctor to continue in practice poses a danger to the public.
The Disciplinary Tribunal is a quasi-judicial administrative body. It conducts quasi-criminal trials of doctors referred to it by the Investigation Panel, to determine whether they are guilty of infamous conduct in a professional respect. Where the Tribunal returns a guilty verdict, it may impose one of three sanctions: admonishment, suspension from the profession, or outright erasure of the practitioner’s name from the Medical Register.
Verdicts of the Disciplinary Tribunal are subject to appeal to the Court of Appeal and, ultimately, the Supreme Court. Sanctioned doctors have repeatedly taken advantage of this right of appeal — from as early as 1959, when Dr Alakija had the order for the erasure of his name from the Medical Register overturned on appeal,⁹ to 2001, when Dr Okonkwo had a similar order against him set aside by the Supreme Court.¹⁰ These and other similar cases have helped to expand the jurisprudence of professional discipline in Nigeria. However, the quest for justice by persons aggrieved by medical malpractice has remained largely unfulfilled — especially in the realm of criminal justice.
The Elusiveness of Criminal Accountability
The Laws of the Federation of Nigeria have included the Criminal Code Act since 1916 and the Penal Code Act since 1960.¹¹ Both statutes contain provisions against the careless and reckless practice of Medicine in their sections dealing with criminal negligence. Nigeria’s socio-political landscape has advanced significantly since the colonial and early post-independence era: the country is now a federation of thirty-six states and a Federal Capital Territory, and, pursuant to the Constitution of the Federal Republic of Nigeria 1999, the state Houses of Assembly have enacted their own versions of the Criminal Code or Penal Code as state laws. Prominent among these is the Criminal Law of Lagos State 2015.¹²
Against this background, it is remarkably difficult to find any record of a successful conviction of a registered medical practitioner in Nigeria for a criminal offence arising from professional practice. One reason is not far-fetched: Medicine is a highly technical profession, extremely difficult for non-doctors to comprehend — to the point of opacity. This necessarily makes it a largely self-regulated profession in most parts of the world. It also means that the determination of wrongdoing against a doctor depends on the professional evidence of his peers.
This was amply demonstrated in the trial of Michael Jackson’s physician, Dr Conrad Murray. In June 2009, Dr Murray, a cardiologist, administered an anaesthetic agent, propofol, by infusion to Michael Jackson at his home to help him sleep, and left him without proper monitoring. Propofol is meant to be administered by anaesthesiologists and critical care specialists; Dr Murray’s specialty, cardiology, conferred no such skills on him. He was charged with involuntary manslaughter. To secure a conviction, the prosecution had to call specialists in anaesthesiology and critical care medicine to testify in court on the accepted standard of practice in the United States. After a protracted trial, Dr Murray was convicted and sentenced to four years in jail, and his licence to practise Medicine was revoked.¹³
Such evidence had proved quite difficult to obtain in Nigeria — until the case of _The State of Lagos v Dr Ejike Ferdinand Orji_,¹⁴ in which the High Court of Lagos State convicted the defendant in January 2023. That conviction is now the subject of an appeal before the Court of Appeal, Lagos Division.
The Facts: The State of Lagos v Dr Ejike Ferdinand Orji
The account that follows is drawn from the evidence before the trial court and the record of the Investigation Panel. Because the conviction is on appeal, the findings it reflects remain open to review by the appellate courts.
The case emanated from a criminal complaint lodged in 2018 against Dr Orji by the parents of Somtochukwu Ezi-Ashi, a sixteen-year-old boy who was, at the time, a high school student in the United States of America, home in Nigeria on holiday. On 26 July 2018, while playing basketball, he fell and sustained an injury to his left leg, later discovered to be a fracture of one of the bones of the left knee joint. He was rushed to Excel C Medical Centre in Ikoyi, Lagos, where Dr Ejike Orji, the Medical Director, sedated him, had a police orderly and a basketball coach who had accompanied him pull the limb in opposite directions, and applied a very tight fibreglass cast to the left lower limb, extending from the top of the thigh to cover the whole of the left foot. He neither obtained the informed consent of the patient’s mother nor carried out an X-ray of the leg to determine the nature of the fracture before manipulating the limb and applying the cast. The doctor only sent the patient for an X-ray at another facility, in Surulere, after the cast had been applied.
As the effect of the sedative wore off, the patient began to complain of excruciating pain and tightness in the leg. His mother telephoned Dr Orji — who had left the hospital before she returned from the X-ray facility with the patient — and complained, but he assured her that the pain would stop within two days. On the strength of this assurance she went home with the patient, only to return to the hospital the following morning because he had been unable to sleep through the night for pain. On examination, Dr Ifeyinwa Grace Orji, the paediatrician who had attended to the patient from childhood, found that he could not move the toes of the left foot. She commented that it was the surgeon’s problem to deal with. Dr Ejike Orji merely cut a square opening at the back of the knee and sent them home. At home, the mother noticed fluid oozing from the opening, and she took the boy back to the hospital the next day, 28 July 2018. He was admitted for one day, and Dr Orji removed part of the cast, but there was no improvement: the leg was massively swollen, and by that time the patient had lost sensation in it. When the cast was removed, about two days after it had been applied, first-degree burns were noticed on the skin of the leg beneath it.
The victim’s father contacted two orthopaedic surgeons for their opinion on what could be done for the patient. It transpired that Somtochukwu had developed compartment syndrome — the result of the conclusion of the blood supply to the limb for more than forty-eight hours by the tight cast. Six surgical interventions were carried out on him at Reddington Hospital, Lagos, before he was flown to the United States, where he underwent several further operations to save the limb.
The limb was saved, but he developed foot drop.
The Police conducted an investigation and submitted a report to the Lagos State Director of Public Prosecutions (DPP), who filed charges against Dr Orji at the High Court of Lagos State.
*The Professional Disciplinary Proceedings*
In addition to the criminal complaint to the Police, the patient’s mother lodged a complaint in March 2019 with the Medical and Dental Practitioners Investigation Panel, alleging that Dr Orji’s management of her son’s condition was negligent.
The Panel investigated the complaint from March 2019 to November 2020. The investigation involved four other doctors at Excel C Medical Centre — including Dr Ifeyinwa Grace Orji — and five doctors at Reddington Hospital who attended to the patient, including Dr Ike Nwachukwu, who performed the six surgical operations there.
The complainant and the respondents appeared before the Panel, where they had the opportunity to clarify their affidavit depositions and other documentary evidence, including the patient’s case notes. The record of proceedings, obtained by the complainant from the Panel, shows that members of the Panel questioned the doctors extensively on the propriety of their actions. Dr Ike Nwachukwu was closely examined on a letter he authored, titled “To Whom It May Concern”, in which he made disparaging remarks about Dr Orji, including referring to him as a quack. His clinical management of the patient did not, however, appear to attract the Panel’s disapproval.
Dr Orji was asked several searching questions: What informed his decision to manipulate the limb without first obtaining an X-ray to determine the nature of the fracture? Why did he apply a fibreglass cast rather than a Plaster of Paris (P.O.P.) cast? Why did he not remove the cast when the patient returned complaining of pain and tightness? What did he hope to achieve by the square cut in the cast at the back of the knee? Why did he not refer the patient to an orthopaedic surgeon, the case being clearly outside his competence as a general surgeon? Did he obtain informed consent from the patient’s mother before commencing the manipulation and application of the cast? His answers were not deemed satisfactory by his assembled professional brethren of good repute and competence. A copy of the investigation report obtained by the complainant shows that the Panel made the following findings:
– Dr Ejike Orji is a General and Paediatric Surgeon; he is not an orthopaedic surgeon.
– Dr Ejike Orji applied a fibreglass cast to the patient at Excel C Medical Centre before the patient was sent elsewhere for an X-ray.
– There is no evidence that appropriate consent was sought and obtained from the patient or his parents by Dr Ejike Orji.
– The patient developed swelling and pain in the left leg after the application of the fibreglass cast; when informed, Dr Ejike Orji only made a square opening in the popliteal area to relieve the pain, and ultimately converted the cast to a back slab after the patient’s father requested its removal.
– The patient was discharged from Excel C Medical Centre in a worse condition before his parents took him to other hospitals for treatment.
– Dr Ike Nwachukwu dealt with the patient as an orthopaedic surgeon at Reddington Hospital, made a diagnosis of compartment syndrome, and treated the patient until he was airlifted for further treatment in the United States of America.
– Dr Ike Nwachukwu made comments in the medical report he issued to the patient, and in his affidavits, that were disparaging of the professional colleague who had first dealt with the patient.
The Panel determined that there was evidence of misconduct in a professional respect against both Dr Ejike Orji and Dr Ike Nwachukwu, and referred each of them to the Disciplinary Tribunal for adjudication.
Before the Disciplinary Tribunal, the Panel preferred a five-count charge against Dr Orji, bordering on gross negligence leading to compartment syndrome and foot drop; manifest incompetence in the assessment of the patient; failure to correctly diagnose his condition; failure to obtain appropriate informed consent before carrying out a surgical procedure on the patient; and causing detriment to the patient by failing to refer him to an orthopaedic surgeon when it was necessary to do so.
He was to be arraigned and tried before the Disciplinary Tribunal in 2021; however, three attempts were stalled by his absence on claims of ill health. He further stalled the proceedings by filing a suit for the enforcement of his fundamental rights against the Tribunal at the High Court of the Federal Capital Territory.
The Criminal Trial, Conviction and Pending Appeal
While the professional case stalled before the Disciplinary Tribunal, the DPP of Lagos State pressed on with the criminal prosecution at the High Court of Lagos State. Dr Orji was re-arraigned in February 2022 on one count of causing grievous bodily harm to Somtochukwu Ezi-Ashi, two counts of endangering human life through reckless and negligent acts, and three counts of breach of duty by a person doing a dangerous act and endangering human life through reckless and dangerous acts, contrary to sections 245, 251(1)(e), 209, 211 and 251(1)(e) respectively of the Criminal Law of Lagos State, Cap C17, Laws of Lagos State 2015.
The judgment shows that the prosecution made copious use of the records of the case obtained by subpoena from the Medical and Dental Practitioners Investigation Panel in marshalling the medical evidence against the defendant. The prosecution also called as witnesses the orthopaedic surgeons who participated in the treatment of the victim after he developed compartment syndrome.
On 20 January 2023, the court convicted Dr Ejike Ferdinand Orji on Counts 2, 3, 4 and 6, and discharged and acquitted him on Counts 1 and 5. He was sentenced to one year’s imprisonment on each of the four counts, the sentences to run concurrently.¹⁵
Dr Orji appealed against his conviction and sentence to the Court of Appeal, Lagos Division, in 2023,¹⁶ and in March 2023 the High Court of Lagos State granted him bail pending the determination of the appeal.¹⁷ The State of Lagos has in turn cross-appealed against his discharge and acquittal on Count 1, asking the Court of Appeal to convict and sentence him on that count.¹⁸ The appeal was fixed for hearing in March 2026; at the time of writing, in October 2026, it has been pending for over three years and has not been determined. The conviction subsists unless and until it is set aside, but it is not yet final: the Court of Appeal may affirm, vary or set it aside, may on the cross-appeal enter a conviction on Count 1, and its decision may itself be taken further to the Supreme Court. As the appeal is sub judice, this article offers no view on its merits.
Conclusion: A Watershed, Pending Appeal
The conviction of Dr Ejike Ferdinand Orji by the High Court of Lagos State is arguably the first conviction of a registered medical practitioner in Nigeria for a criminal offence arising from professional practice. Whatever the outcome of the appeal, the trial has already marked a watershed in one important respect: it showed that the evidential obstacle which has so long frustrated criminal accountability can be overcome, through the records of the Investigation Panel obtained by subpoena and the testimony of specialists in the relevant field.
The decision of the Court of Appeal will carry its own significance. Whether it affirms, varies or sets aside the conviction, it is likely to be the first appellate pronouncement on the criminal liability of a registered practitioner for conduct in the course of professional practice, and so to shape the standard against which such prosecutions are measured. Its determination is awaited with keen interest by the profession, the regulator and the public — in the hope that the law will, in the end, both protect patients from reckless and negligent practice and give doctors clear guidance on where the line of criminal liability is drawn.
It should be noted that at the heart of every instance of medical negligence, is a human story that no judgment, however meticulously reasoned, can fully capture. Behind the clinical terminology, the medical records, the expert opinions and the solemn language of the courtroom lies the trembling heart of a parent who entrusted a child to the healing profession and expected that child to return home better, or at least no worse, than when he entered the hospital. When that trust is betrayed, the injury extends far beyond the body of the patient. It enters the home, settles into the consciousness of the family and leaves an absence that medical compensation, professional discipline or judicial pronouncement may never completely fill. For a parent, the knowledge that a child’s suffering or permanent disability may have resulted from conduct that could have been avoided carries a particularly cruel burden. It is the burden of what if: what if the danger had been recognised earlier; what if the appropriate diagnosis or investigation had been undertaken; what if the warning signs had been heeded; what if the limits of professional competence had been acknowledged; what if the child had been referred in time? These questions can haunt a family long after the hospital doors have closed and the courtroom has fallen silent. The deepest tragedy of preventable medical harm is therefore not simply that the body suffers, but that a future suffers with it—the future imagined by parents, the future anticipated by the child, and the ordinary joys of life that may forever remain beyond reach.
Yet the law cannot answer such anguish by emotion alone. Its duty is more difficult and, perhaps, more profound. It must construct a principled boundary between the inevitable imperfections of medical practice and conduct deserving of legal condemnation. A doctor cannot be made criminally liable merely because treatment fails, for medicine does not confer omnipotence upon those who practise it. But neither should the language of professional judgment become an impenetrable fortress behind which gross incompetence, disregard of elementary precautions, failure to obtain informed consent, refusal to recognise professional limitations or indifference to obvious signs of deterioration can hide from accountability. The protection of medical practitioners and the protection of patients are not competing ideals; properly understood, they are complementary obligations of a mature legal system. The former ensures that doctors may exercise legitimate clinical judgment without the paralysis of perpetual fear; the latter ensures that the authority entrusted to doctors is exercised with the competence, care and humanity that such authority demands. The jurisprudential challenge is therefore to punish not the mere fact of an unsuccessful outcome, but culpable conduct proved according to law. Where that threshold is crossed, accountability is not an assault upon the medical profession; it is a reaffirmation of the ethical foundation upon which the profession itself rests. For the law ultimately owes a duty to the living, the injured and the grieving alike. It must speak for the patient whose voice has been silenced by injury, for the parents whose hopes have been transformed into memories, and for a society that must be able to trust that the white coat signifies not merely knowledge, but responsibility. The enduring lesson is therefore both simple and solemn: the sanctity of the healing profession cannot depend upon the absence of accountability; it must depend upon accountability worthy of the trust that society places in the healer. Where a life is placed in another’s hands, that trust is not ornamental, it is a responsibility. And where that responsibility is gravely betrayed, the law must have the courage, the wisdom and the humanity to ask not merely what went wrong, but whether it should ever have been allowed to happen at all.
Footnotes:
1. D. A. Warrell, T. M. Cox and J. D. Firth (eds), Oxford Textbook of Medicine (6th edn, Oxford University Press 2020).
2. The Hippocratic Oath, attributed to Hippocrates of Kos (c. 5th–4th century BC).
3. Avicenna (Ibn Sīnā), The Canon of Medicine (Al-Qānūn fī al-Ṭibb, c. 1025 AD).
4. Thomas Percival, Medical Ethics; or, a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons (Manchester, 1803).
5. Apothecaries Act 1815 (UK), 55 Geo. III, c. 194.
6. Medical and Dental Practitioners Act, Cap M8, Laws of the Federation of Nigeria 2004 (first enacted as the Medical and Dental Practitioners Act 1963; repealed and re-enacted by the Medical and Dental Practitioners Decree No. 23 of 1988; amended by Decree No. 78 of 1992).
7. Medical and Dental Practitioners Act, Cap M8, LFN 2004, s. 1.
8. Medical and Dental Practitioners Act, Cap M8, LFN 2004, s. 15.
9. Alakija v Medical Disciplinary Committee (1959) 4 FSC 38; [1959] SCNLR 372.
10. Medical and Dental Practitioners Disciplinary Tribunal v Okonkwo (2001) 7 NWLR (Pt. 711) 206 (SC).
11. Criminal Code Act, Cap C38, Laws of the Federation of Nigeria 2004 (originally enacted 1916); Penal Code Act 1960 (applicable to Northern Nigeria).
12. Criminal Law of Lagos State, Cap C17, Laws of Lagos State 2015.
13. People v Conrad Robert Murray, Superior Court of California, County of Los Angeles, Case No. SA073164; verdict delivered 7 November 2011; sentenced 29 November 2011 to four years’ imprisonment.
14. The State of Lagos v Dr Ejike Ferdinand Orji (unreported), Charge No. LD/8963C/2019, High Court of Lagos State (Akintoye J).
15. The State of Lagos v Dr Ejike Ferdinand Orji (unreported), Charge No. LD/8963C/2019, High Court of Lagos State, judgment delivered 20 January 2023 (Akintoye J); on appeal to the Court of Appeal, Lagos Division.
16. Ejike Ferdinand Orji v The State of Lagos, Court of Appeal, Lagos Division (pending).
17. The State of Lagos v Dr Ejike Ferdinand Orji (unreported), High Court of Lagos State, ruling on application for bail pending appeal (Harrison J), March 2023; reported in ThisDay, 21 March 2023.
18. Cross-appeal by the State of Lagos against the discharge and acquittal on Count 1; reported in The Guardian (Nigeria), 15 October 2025.